Relationships between cardiovascular disease risk, neuropathic pain, mental health, and autonomic function in chronic spinal cord injury.

STUDY DESIGN: Multicentre, cross-sectional study. OBJECTIVES: To determine if clinical measures of poor mental health (MH-) and neuropathic pain (NP) are related to increased CVD risk in individuals with chronic spinal cord injury (SCI), and further elucidate the relationships between CVD risk, autonomic function, NP, and MH-. SETTING: Eight SCI rehabilitation centres in the Netherlands. METHODS: Individuals (n = 257) with a traumatic, chronic (≥10 yrs) SCI, with age at injury between 18-35 years, completed a self-report questionnaire and a one-day visit to a rehabilitation centre for testing. CVD risk was calculated using Framingham risk score. NP was inferred using The Douleur Neuropathique 4 clinical examination, and MH- was assessed using the five-item Mental Health Inventory questionnaire. Cardiovascular autonomic function was determined from peak heart rate during maximal exercise (HRpeak). RESULTS: There was a high prevalence of both NP (39%) and MH- (45%) following SCI. MH- was significantly correlated with an adverse CVD risk profile (r = 0.174; p = 0.01), increased the odds of adverse 30-year CVD risk by 2.2 (CI 0.92-2.81, p = 0.02), and is an important variable in determining CVD risk (importance=0.74, p = 0.05). Females (p = 0.05) and those with a higher HRpeak (p = 0.046) tended to be more likely to have NP. CONCLUSIONS: Clinical measures of MH-, but not NP, are important factors for increased CVD risk following SCI. NP tended to be more prevalent in those with more preserved cardiovascular autonomic function. The interrelationships between secondary consequences of SCI are complex and need further exploration.

Multiple Functional Brain Networks Related to Pain Perception Revealed by fMRI.

The rise of functional magnetic resonance imaging (fMRI) has led to a deeper understanding of cortical processing of pain. Central to these advances has been the identification and analysis of "functional networks", often derived from groups of pre-selected pain regions. In this study our main objective was to identify functional brain networks related to pain perception by examining whole-brain activation, avoiding the need for a priori selection of regions. We applied a data-driven technique-Constrained Principal Component Analysis for fMRI (fMRI-CPCA)-that identifies networks without assuming their anatomical or temporal properties. Open-source fMRI data collected during a thermal pain task (33 healthy participants) were subjected to fMRI-CPCA for network extraction, and networks were associated with pain perception by modelling subjective pain ratings as a function of network activation intensities. Three functional networks emerged: a sensorimotor response network, a salience-mediated attention network, and the default-mode network. Together, these networks constituted a brain state that explained variability in pain perception, both within and between individuals, demonstrating the potential of data-driven, whole-brain functional network techniques for the analysis of pain imaging data.

Evaluation of cardiovascular disease risk in individuals with chronic spinal cord injury.

STUDY DESIGN: Multicentre, cross-sectional study. OBJECTIVES: To identify which markers of obesity, injury characteristics and autonomic function variables are related to cardiovascular disease (CVD) risk after spinal cord injury (SCI), and establish cut-points for detection and risk management. SETTING: Eight SCI rehabilitation centres in the Netherlands. METHODS: Individuals (n = 257) with a traumatic, chronic (≥10 years) SCI, with age at injury between 18 and 35 years, completed a self-report questionnaire and a one-day visit to a rehabilitation centre for testing. Three anthropometric measures were tested: body mass index (BMI); waist circumference (WC); and waist-to-height ratio (WHtR). Injury characteristics included: American Spinal Injury Association impairment scale (AIS); duration of injury (DOI); and neurological level of injury (LOI). Cardiovascular autonomic function was assessed from peak heart rate during maximal exercise (HRpeak). Systolic arterial pressure (SAP) and aerobic capacity (VO2peak) were also determined. CVD risk was calculated using the Framingham risk score (FRS). RESULTS: All anthropometric variables were associated with FRS, with WC showing the strongest correlation (r = 0.41, p < 0.001) and greatest area under the curve (0.73) for 10-year CVD risk (%). WC, DOI, SAP, HRpeak, LOI, and VO2peak (variable importance: 0.81, 1.0, 0.98, 0.98, 0.66, 0.68, respectively) were important predictive variables for 10-year CVD risk in individuals with SCI. CONCLUSIONS: We confirm that WC is a simple, practical measure of CVD risk, and along with DOI and markers of cardiovascular autonomic function, plays a role in the increased CVD risk following SCI.

Tutorial for the Characterization of Fatty Acid Methyl Esters by Gas Chromatography with Highly Polar Capillary Columns.

The fatty acid composition of fats and oils is commonly determined by gas chromatography after preparing fatty acid methyl esters (FAME). Capillary columns coated with polyethylene glycol emerged as the preferred separation tool for the quantification of the polyunsaturated fatty acids contained primarily in marine oils. However, their selectivity is inadequate for measuring the trans fatty acids (TFA) contained in refined vegetable oils, dairy fats, and marine oils. Highly polar 100% poly(biscyanopropyl siloxane) capillary columns provide the necessary selectivity, but small differences in the phase polarity caused by column age, conditioning, or manufacturing variations affect the reproducibility of their separations of these complex samples. In this study, a simple procedure is described to compensate for small variations in column selectivity by adjusting the elution temperature. The balance between the dipole-induced dipole interactions and dispersive interactions was determined by measuring selectivity factors [SF(i)] corresponding to the elution of an unsaturated FAME such as 18:3n-3 relative to two saturated FAME such as 20:0 and 22:0. Knowing the SF(i) provided by the installed capillary column at a given elution temperature, and the SF(i) of the target separation, we propose a simple calculation to determine the necessary elution temperature adjustment to achieve (or restore) the desired separation. After determining the SF(i) which provides the optimal separation of TFA, the novel methodology was applied to the separation of refined vegetable oils, butter fats, and marine oils.

Recovery after traumatic thoracic- and lumbar spinal cord injury: the neurological level of injury matters.

STUDY DESIGN: Multicenter prospective cohort. OBJECTIVE: To discern neurological- and functional recovery in patients with a traumatic thoracic spinal cord injury (TSCI), conus medullaris syndrome (CMS), and cauda equina syndrome (CES). SETTING: Specialized spinal cord injury centers in Europe. METHOD: Lower extremity motor score (LEMS) and spinal cord independent measure (SCIM) scores from patients with traumatic TSCI, CMS, and CES were extracted from the EMSCI database. Scores from admittance and during rehabilitation at 1, 3, 6, and 12 months were compared. Linear mixed models were used to statistically analyse differences in outcome, which were corrected for the ASIA Impairment Scale (AIS) in the acute phase. RESULTS: Data from 1573 individuals were analysed. Except for the LEMS in patients with a CES AIS A, LEMS, and SCIM significantly improved over time for patients with a TSCI, CMS, and CES. Irrespectively of the AIS score, recovery in 12 months after trauma as measured by the LEMS showed a statistically significant difference between patients with a TSCI, CMS, and CES. Analysis of SCIM score showed no difference between patients with TSCI, CMS, or CES. CONCLUSION: Difference in recovery between patients with a traumatic paraplegia is based on neurological (motor) recovery. Regardless the ceiling effect in CES patients, patients with a mixed upper and lower motor neuron syndrome (CMS) showed a better recovery compared with patients with a upper motor neuron syndrome (TSCI). These findings enable stratifications of patients with paraplegia according to the level and severity of SCI.

Separation and characterization of products from acidic methanolysis of plasmalogenic lipids by two-dimensional gas chromatography with online reduction.

The complexity of determining the composition of animal tissue lipids is greatly increased by the presence of plasmalogens in which the alkyl chain is linked to glycerol by an enol ether bond instead of being esterified. Acidic methanolysis of animal tissue lipids provides the simultaneous scission of acyl and alkenyl ether moieties, but the complexity of the products of reaction poses a great challenge in their gas chromatographic analysis. Two-dimensional gas chromatography with online reduction (GC-OR × GC) provided the resolution of all components contained in acid methanolyzed animal lipids, taking advantage of the selective hydrogenation of alkenyl ether methanolysis products prior to the second-dimension separation (2D). In this study, we also studied the chemical transformations occurring during the acidic methanolysis of animal lipids and the subsequent gas chromatographic analysis. In particular, we observed that using methanolysis reagents contaminated with water resulted in the undesired formation of fatty aldehydes, and we made recommendations on how to avoid these side reactions using proper methanolysis conditions. Products of acidic methanolysis were studied by GC-OR × GC, GC-MS, NMR spectroscopy, and GC with flame ionization detection (GC-FID). We defined the GC-FID elution order of animal lipid acidic methanolysis products using 100 m × 0.25 mm 100% bis(cyanopropyl)siloxane columns and two different set of elution conditions: isothermal elution at 180°C, and a temperature program optimized for dairy fats. A simple procedure for isolating dimethyl acetals (DMA) prior to GC analysis is also described.

Myelin water imaging data analysis in less than one minute.

PURPOSE: Based on a deep learning neural network (NN) algorithm, a super fast and easy to implement data analysis method was proposed for myelin water imaging (MWI) to calculate the myelin water fraction (MWF). METHODS: A NN was constructed and trained on MWI data acquired by a 32-echo 3D gradient and spin echo (GRASE) sequence. Ground truth labels were created by regularized non-negative least squares (NNLS) with stimulated echo corrections. Voxel-wise GRASE data from 5 brains (4 healthy, 1 multiple sclerosis (MS)) were used for NN training. The trained NN was tested on 2 healthy brains, 1 MS brain with segmented lesions, 1 healthy spinal cord, and 1 healthy brain acquired from a different scanner. RESULTS: Production of whole brain MWF maps in approximately 33 â€‹s can be achieved by a trained NN without graphics card acceleration. For all testing regions, no visual differences between NN and NNLS MWF maps were observed, and no obvious regional biases were found. Quantitatively, all voxels exhibited excellent agreement between NN and NNLS (all R2>0.98, p â€‹< â€‹0.001, mean absolute error <0.01). CONCLUSION: The time for accurate MWF calculation can be dramatically reduced to less than 1 â€‹min by the proposed NN, addressing one of the barriers facing future clinical feasibility of MWI.

The Effect of Non-Gabapentinoid Anticonvulsants on Sensorimotor Recovery After Human Spinal Cord Injury.

BACKGROUND: Recent observational studies have shown an association between gabapentinoid anticonvulsants and greater motor recovery after spinal cord injury. There is preclinical evidence to suggest that other anticonvulsants, such as sodium channel blockers, may also confer beneficial effects. PURPOSE: The aim of the current study was to determine if non-gabapentinoid anticonvulsants were associated with neurological recovery after acute, traumatic spinal cord injury. METHODS: This was an observational cohort study using data from the Sygen clinical trial. The primary outcome was total motor score recovery in the first year after injury. Anticonvulsant use was extracted from concomitant medication records; individuals were classified based on early administration (within 30 days of injury), or late/no administration. Motor recovery was compared using linear mixed effects regression models with a drug-by-time interaction, and adjustment for confounders. A secondary analysis incorporated a propensity score matched cohort. RESULTS: Of the cohort (n = 570), 6% received anticonvulsants (carbamazepine, phenytoin, clonazepam, phenobarbital, and valproic acid) early after injury. After adjustments for initial injury level and severity, early exposure to non-gabapentinoid anticonvulsants was not associated with motor neurological outcomes (p = 0.38 for all anticonvulsants, p = 0.83 for sodium channel blockers, p = 0.82 in propensity-matched cohort). CONCLUSION: Non-gabapentinoid anticonvulsant exposure was not associated with greater or lesser neurological recovery. This suggests that these medications, as administered for the acute management of spinal cord injury, do not impact long-term neurological outcomes.

Pan-Canadian Estimates of Chronic Pain Prevalence From 2000 to 2014: A Repeated Cross-Sectional Survey Analysis.

Recent temporal trends in the population prevalence of chronic pain in Canada on a national and provincial level are unknown. Five cycles of the Canadian Community Health Survey (2000/2001, 2007/2008, 2009/2010, 2011/2012, and 2013/2014) were used to derive population-based estimates of the self-reported prevalence of chronic pain. Sensitivity analyses examined chronic pain prevalence among those reporting no other chronic health conditions. The prevalence of chronic pain among the general Canadian population increased by almost 4.0% (to 21.0%) in 2011/2012, after being in the range of 15.7 to 17.2% from 2000 to 2009/2010. The sudden increase in prevalence was observed 1) across all provinces in Canada, 2) in all age categories, and 3) among Canadians with no other chronic health conditions. Increasing chronic pain prevalence in Canada, most significantly occurring between 2010 and 2012, and including among healthy and young individuals, emphasizes the need for targeted research and resources to help alleviate chronic pain. PERSPECTIVE: This study uncovers a significant increase in chronic pain prevalence in Canada between 2009/2010 and 2011/2012, driven by younger Canadians that are free of the most common chronic health conditions. This discovery emphasizes the importance of further directed research and resources to help mitigate the trend of increasing chronic pain.

Prevalence of chronic pain among individuals with neurological conditions.

BACKGROUND: The prevalence of pain among people with a variety of individual neurological conditions has been estimated. However, information is limited about chronic pain among people with neurological conditions overall, and about the conditions for which chronic pain is most prevalent. To fill these information gaps, a common method of pain assessment is required. DATA AND METHODS: The data are from the Survey on Living with Neurological Conditions in Canada, a cross-sectional national survey. Based on self-reports, chronic pain was assessed for 16 neurological conditions. Multivariable logistic regression was used to produce odds ratios and 95% confidence intervals (CIs). RESULTS: Close to 1.5 million individuals aged 15 or older who lived in private households reported having been diagnosed with a neurological condition. The overall prevalence of chronic pain for the 16 neurological conditions combined was 36% (95% CI: 31% to 42%). The odds of chronic pain were significantly elevated among individuals with spinal cord trauma. DISCUSSION: Chronic pain is highly prevalent among people with neurological conditions, particularly those with spinal cord trauma. These results suggest a need to target health services and direct research to improved pain management, and thereby reduce the burden of neurological disease.

Evidence for the Initial Steps of DHA Biohydrogenation by Mixed Ruminal Microorganisms from Sheep Involves Formation of Conjugated Fatty Acids.

Incubation of DHA with sheep rumen fluid resulted in 80% disappearance in 6 h. The products were analyzed as their fatty acid (FA) methyl esters by GC-FID on SP-2560 and SLB-IL111 columns. The GC-online reduction × GC and GC-MS techniques demonstrated that all DHA metabolites retained the C22 structure (no evidence of chain-shortening). Two new transient DHA products were identified: mono-trans methylene interrupted-DHA and monoconjugated DHA (MC-DHA) isomers. Identification of MC-DHA was confirmed by their predicted elution using equivalent chain length differences from C18 FA, their molecular ions, and the 22:5 products formed which were the most abundant at 6 h. The 22:5 structures were established by fragmentation of their 4,4-dimethyloxazoline derivatives, and all 22:5 products contained an isolated double bond, suggesting formation via MC-DHA. The most abundant c4,c7,c10,t14,c19-22:5 appeared to be formed by unknown isomerases. Results suggest that the initial biohydrogenation of DHA was analogous to that of C18 FA.

Improvement of the Fourier Transform Near Infrared Method to Evaluate Extra Virgin Olive Oils by Analyzing 1,2-Diacylglycerols and 1,3-Diacylglycerols and Adding Unesterified Fatty Acids.

Extra virgin olive oils (EVOO) command higher prices because they contain health-promoting nutrients and desirable sensory characteristics. Many targeted methods have limited success in determining olive oil authenticity. Therefore, attention has been paid to rapid spectroscopic methods that provide the composition of multiple components. A Fourier transform near infrared (FT-NIR) method was reported that identified five major fatty acids and volatiles in EVOO, plus four models that identify common adulterants and their content. However, it did not include diacylglycerol (DAG) and unesterified fatty acids (FFA) known to be associated with freshness of the oil. The newly improved FT-NIR method now includes 1,2-DAG and 1,3-DAG models based on the DAG isomer content in freshly prepared EVOO, and a FFA model based on quantitative addition of oleic acid. The new FT-NIR method was used to reassess previously used EVOO products to evaluate their freshness. Based on these results and review of the published data, we propose several revisions to the EVOO regulation: limit FFA to ≤0.5%, include 1,2-DAG and 1,3-DAG in standard, place no limit on 1,2-DAG because it characterizes the oils, set the 1,3-DAG content to ≤1.0%, and lower the content of 18:2n-6 to 1.5%.

First Application of Newly Developed FT-NIR Spectroscopic Methodology to Predict Authenticity of Extra Virgin Olive Oil Retail Products in the USA.

Economically motivated adulteration (EMA) of extra virgin olive oils (EVOO) has been a worldwide problem and a concern for government regulators for a long time. The US Food and Drug Administration (FDA) is mandated to protect the US public against intentional adulteration of foods and has jurisdiction over deceptive label declarations. To detect EMA of olive oil and address food safety vulnerabilities, we used a previously developed rapid screening methodology to authenticate EVOO. For the first time, a recently developed FT-NIR spectroscopic methodology in conjunction with partial least squares analysis was applied to commercial products labeled EVOO purchased in College Park, MD, USA to rapidly predict whether they are authentic, potentially mixed with refined olive oil (RO) or other vegetable oil(s), or are of lower quality. Of the 88 commercial products labeled EVOO that were assessed according to published specified ranges, 33 (37.5%) satisfied the three published FT-NIR requirements identified for authentic EVOO products which included the purity test. This test was based on limits established for the contents of three potential adulterants, oils high in linoleic acid (OH-LNA), oils high in oleic acid (OH-OLA), palm olein (PO), and/or RO. The remaining 55 samples (62.5%) did not meet one or more of the criteria established for authentic EVOO. The breakdown of the 55 products was EVOO potentially mixed with OH-LNA (25.5%), OH-OLA (10.9%), PO (5.4%), RO (25.5%), or a combination of any of these four (32.7%). If assessments had been based strictly on whether the fatty acid composition was within the established ranges set by the International Olive Council (IOC), less than 10% would have been identified as non-EVOO. These findings are significant not only because they were consistent with previously published data based on the results of two sensory panels that were accredited by IOC but more importantly each measurement/analysis was accomplished in less than 5 min.

Early Administration of Gabapentinoids Improves Motor Recovery after Human Spinal Cord Injury.

The anticonvulsant pregabalin promotes neural regeneration in a mouse model of spinal cord injury (SCI). We have also previously observed that anticonvulsants improve motor outcomes following human SCI. The present study examined the optimal timing and type of anticonvulsants administered in a large, prospective, multi-center, cohort study in acute SCI. Mixed-effects regression techniques were used to model total motor scores at 1, 3, 6, and 12 months post injury. We found that early (not late) administration of anticonvulsants significantly improved motor recovery (6.25 points over 1 year). The beneficial effect of anticonvulsants remained significant after adjustment for differences in 1-month motor scores and injury characteristics. A review of a subset of patients revealed that gabapentinoids were the most frequently administrated anticonvulsant. Together with preclinical findings, intervention with anticonvulsants represents a potential pharmacological strategy to improve motor function after SCI.

An assessment of the fatty acid composition of horse-meat available at the retail level in northern Spain.

The objective of the present study was to assess the fatty acid composition of horse-meat available at the retail market in northern Spain. Horse steaks (Longissimus thoracis et lumborum muscle; n=82) were purchased from butcher-shops and large grocery stores throughout six northern regions of Spain in two different seasons. Fat content differed significantly among regions (1.12 to 2.77%). Samples with higher intramuscular fat content presented the highest percentages of total monounsaturated fatty acids and the lowest contents of dimethylacetal and polyunsaturated fatty acids (PUFA), while the opposite was found in the leanest samples. A high variability was observed in the muscle and subcutaneous n-3 PUFA content. Overall, total n-3 PUFA content ranged between 1.17% and 18.9% in muscle fat and between 1.52% and 27.9% in backfat. Interestingly, almost 5% of surveyed loins from horse carcasses (4 out of 82) contained over 300mg of linolenic acid per 100g of meat which could have been marketed as a "source" of n-3 FAs according to Commission Regulation (EU) No 116/2010.

Developing FT-NIR and PLS1 Methodology for Predicting Adulteration in Representative Varieties/Blends of Extra Virgin Olive Oils.

It was previously demonstrated that Fourier transform near infrared (FT-NIR) spectroscopy and partial least squares (PLS1) were successfully used to assess whether an olive oil was extra virgin, and if adulterated, with which type of vegetable oil and by how much using previously developed PLS1 calibration models. This last prediction required an initial set of four PLS1 calibration models that were based on gravimetrically prepared mixtures of a specific variety of extra virgin olive oil (EVOO) spiked with adulterants. The current study was undertaken after obtaining a range of EVOO varieties grown in different countries. It was found that all the different types of EVOO varieties investigated belonged to four distinct groups, and each required the development of additional sets of specific PLS1 calibration models to ensure that they can be used to predict low concentrations of vegetable oils high in linoleic, oleic, or palmitic acid, and/or refined olive oil. These four distinct sets of PLS1 calibration models were required to cover the range of EVOO varieties with a linoleic acid content from 1.3 to 15.5 % of total fatty acids. An FT-NIR library was established with 66 EVOO products obtained from California and Europe. The quality and/or purity of EVOO were assessed by determining the FT-NIR Index, a measure of the volatile content of EVOO. The use of these PLS1 calibration models made it possible to predict the authenticity of EVOO and the identity and quantity of potential adulterant oils in minutes.

Characterization of the fatty acid composition of lamb commercially available in northern Spain: Emphasis on the trans-18:1 and CLA content and profile.

A survey of commercially available lamb meat was performed in northern Spain in order to evaluate their fatty acid (FA) composition with emphasis on trans fatty acid (TFA) and conjugated linoleic acid (CLA) isomers. Samples were collected in spring (n=24) and winter (n=24) of 2013, and were obtained in about equal numbers from grocery stores and butcher-shops. Subcutaneous fat, known to be a sensitive indicator of TFA content in ruminants, was analyzed by GC-FID. In general, very few differences were observed between collection periods and type of stores because of the high variability within the groups that was believed to be associated with differences in genetics and feeding strategies. However, the 10t/11t ratio of all samples showed two clearly identifiable groups irrespective of the source: 1) when 10t/11t was >1, 10t-shifted samples; 2) when 10t/11t was ≤1, non-shifted samples where 11t-18:1 was the predominant isomer. These two groups were clearly identified and associated with distinct FAs using principal component analysis.

Effects of Pain and Pain Management on Motor Recovery of Spinal Cord-Injured Patients: A Longitudinal Study.

Background Approximately 60% of patients suffering from acute spinal cord injury (SCI) develop pain within days to weeks after injury, which ultimately persists into chronic stages. To date, the consequences of pain after SCI have been largely examined in terms of interfering with quality of life. Objective The objective of this study was to examine the effects of pain and pain management on neurological recovery after SCI. Methods We analyzed clinical data in a prospective multicenter observational cohort study in patients with SCI. Using mixed effects regression techniques, total motor and sensory scores were modelled at 1, 3, 6, and 12 months postinjury. Results A total of 225 individuals were included in the study (mean age: 45.8 ± 18 years, 80% male). At 1 month postinjury, 28% of individuals with SCI reported at- or below-level neuropathic pain. While pain classification showed no effect on neurological outcomes, individuals administered anticonvulsant medications at 1 month postinjury showed significant reductions in pain intensity (2 points over 1 year; P < .05) and greater recovery in total motor scores (7.3 points over 1 year; P < .05). This drug effect on motor recovery remained significant after adjustment for injury level and injury severity, pain classification, and pain intensity. Conclusion While initial pain classification and intensity did not reveal an effect on motor recovery following acute SCI, anticonvulsants conferred a significant beneficial effect on motor outcomes. Early intervention with anticonvulsants may have effects beyond pain management and warrant further studies to evaluate the therapeutic effectiveness in human SCI.